Variation patterns of cervical alignment in ankylosing spondylitis–related thoracolumbar kyphosis following pedicle subtraction osteotomy in the sitting position: an EOS-based investigation

OBJECTIVE Both unchanged upper cervical lordosis combined with decreased lower cervical lordosis and decreased upper cervical lordosis combined with decreased lower cervical lordosis have been reported to occur after correction surgery for adult spinal deformity. However, variations in cervical alignment after correction surgery in patients with ankylosing spondylitis (AS) have not been investigated. The current study aimed to investigate the variations in cervical alignment following the correction surgery in AS patients with thoracolumbar kyphosis. METHODS Patients with AS who underwent pedicle subtraction osteotomy (PSO) for thoracolumbar kyphosis from June 2016 to June 2019 with a minimum of 1-year follow-up were reviewed. Patients were grouped according to the presence (ossified group) and absence (non-ossified group) of total ossification of the anterior longitudinal ligament (ALL) in the lower cervical spine. Radiographic parameters, including thoracolumbar, craniocervical, and global radiographic parameters, were measured on lateral sitting EOS images. RESULTS Thirty-two patients (27 males and 5 females) with a mean follow-up of 1.5 years were identified. There were 21 patients in the non-ossified group and 11 patients in the ossified group. After PSO, both groups showed a decrease in the occiput–C7 angle (p < 0.001 for both). In the non-ossified group, the C2–7 angle decreased significantly (p < 0.001), while the occiput–C2 angle remained unchanged (p = 0.570). In the ossified group, the occiput–C2 angle decreased significantly (p < 0.001), while C2–7 angle remained unchanged (p = 0.311). In addition, the change in occiput–C2 was correlated with the osteotomy angle in the ossified group (R = 0.776, p = 0.005). CONCLUSIONS The variation patterns of cervical alignment following correction surgery for AS-related thoracolumbar kyphosis were different based on patients with or without total ossification of ALL in the lower cervical spine. When planning PSO for patients in the ossified group, restoration of the physiological upper cervical lordosis angle could be achieved by adjusting the osteotomy angle.

Download Full-text

Posterior Temporary C1-2 Pedicle Screws Fixation for the Treatment of Unstable C1-2 Complex Fractures: Minimum of 2-Year Follow-Up

Global Spine Journal ◽

10.1177/21925682211039186 ◽

2021 ◽

pp. 219256822110391

Author(s):

Yakubu Ibrahim ◽

Hao Li ◽

Geng Zhao ◽

Suomao Yuan ◽

Yiwei Zhao ◽

...

Keyword(s):

Cervical Spine ◽

Internal Fixation ◽

Neck Disability Index ◽

Pedicle Screws ◽

Rotary Motion ◽

Upper Cervical Spine ◽

Complex Fractures ◽

Upper Cervical ◽

Better Than

Study Design: Retrospective. Objectives: To present rarely reported complex fractures of the upper cervical spine (C1-C2) and discuss the clinical results of the posterior temporary C1-2 pedicle screws fixation for C1-C2 stabilization. Methods: A total of 19 patients were included in the study (18 males and 1 female). Their age ranged from 23 to 66 years (mean age of 39.6 years). The patients were diagnosed with complex fractures of the atlas and the axis of the upper cervical spine and underwent posterior temporary C1-2 pedicle screws fixation. The patients underwent a serial postoperative clinical examination at approximately 3, 6, 9 months, and annually thereafter. The neck disability index (NDI) and the range of neck rotary motion were used to evaluate the postoperative clinical efficacy of the patients. Results: The average operation time and blood loss were 110 ± 25 min and 50 ± 12 ml, respectively. The mean follow-up was 38 ± 11 months (range 22 to 60 months). The neck rotary motion before removal, immediately after removal, and the last follow-up were 68.7 ± 7.1°, 115.1 ± 11.7°, and 149.3 ± 8.9° ( P < 0.01). The NDI scores before and after the operation were 42.7 ± 4.3, 11.1 ± 4.0 ( P < 0.01), and the NDI score 2 days after the internal fixation was removed was 7.3 ± 2.9, which was better than immediately after the operation ( P < 0.01), and 2 years after the internal fixation was removed. The NDI score was 2.0 ± 0.8, which was significantly better than 2 days after the internal fixation was taken out ( P < 0.001). Conclusions: Posterior temporary screw fixation is a good alternative surgical treatment for unstable C1-C2 complex fractures.

Download Full-text

Characteristics of Ossified Lesions in the Upper Cervical Spine Associated with Ossification of the Posterior Longitudinal Ligament in the Lower Cervical Spine

The Journal of Bone and Joint Surgery (American) ◽

10.2106/jbjs.g.00037 ◽

2008 ◽

Vol 90 (4) ◽

pp. 748-753 ◽

Cited By ~ 7

Author(s):

Yoshiharu Kawaguchi ◽

Shoji Seki ◽

Takeshi Hori ◽

Tomoatsu Kimura

Keyword(s):

Cervical Spine ◽

Posterior Longitudinal Ligament ◽

Upper Cervical Spine ◽

Lower Cervical Spine ◽

Upper Cervical

Download Full-text

A Correlation Analysis Between Postoperative Dysphagia and Change of C2-C7 Angle after Anterior Cervical Spine Surgery

10.21203/rs.3.rs-200427/v1 ◽

2021 ◽

Author(s):

Jie Yu ◽

Xiaohui Tao

Keyword(s):

Cervical Spine ◽

Spinal Surgery ◽

Cervical Disc ◽

Cervical Lordosis ◽

Postoperative Dysphagia ◽

Cervical Spine Surgery ◽

Cervical Disc Replacement ◽

Anterior Cervical Spine Surgery ◽

Angle Change

Abstract Background. Dysphagia after cervical spinal surgery is one of highly prevalent comorbidities in clinical practice. Studies suggest that excessive O-C2 angle change at occipital-cervical fusion causes the oropharyngeal volume reduction leading to severe dysphagia and even respiratory distress after operation. However, rare study has accessed the impact of C2-C7 angle change on the occurrence of dysphagia after anterior cervical spinal surgery. Methods. From June 2007 to May 2010, A total of 198 patients was treated with anterior cervical decompression and plate fixation and 12 months follow-up was completed in 172 patients. Within the same session, a total of 154 patients underwent anterior cervical disc replacement and at least 1-year follow-up was completed in 98 patients. All 270 patients who participated in this study completed a questionnaire (Bazaz dysphagia questionnaire) after telephone follow-up including the onset and time of appearance of dysphagia, symptom relief, treatment plan and so on. To determine whether excessive cervical lordosis change (change of C2-C7 angle) and other risk factors were associated with the dysphagia symptom, all patients were divided into the dysphagia group and the control group, followed over 12 months.Results. The results showed that 12.8% presented with postoperative dysphagia in anterior cervical discectomy and fusion (ACDF) group and 5.1% in cervical disc replacement (CDR) group. According to the regression equation, the excessive change of C2-C7 angle can significantly increase the incidence rate of postoperative dysphagia. The incidence rate of postoperative dysphagia in patients whose C2-C7 angle change more than 5 degree was significantly greater than patients less than 5 degree. Sex, age, BMI, operation time, blood loss, surgery approach (anterior/posterior), revision ratio, the number of surgical segments, the highest surgical segment, and C3 segment included or not cannot affect the occurrence of dysphagia. Conclusions. Dysphagia after cervical spinal surgery is one of highly prevalent comorbidities. Cervical lordosis change is an important influencing factor on the occurrence of dysphagia after anterior cervical spine surgery.

Download Full-text

Atlantal fracture with transverse ligament disruption in a child

Journal of Neurosurgery Pediatrics ◽

10.3171/2009.4.peds0973 ◽

2009 ◽

Vol 4 (3) ◽

pp. 196-198 ◽

Cited By ~ 2

Author(s):

Marcelo D. Vilela ◽

Eric C. Peterson

Keyword(s):

Cervical Spine ◽

Surgical Treatment ◽

Upper Cervical Spine ◽

Transverse Ligament ◽

Jefferson Fracture ◽

Fractures In Children ◽

Upper Cervical ◽

Almost All ◽

Ligament Disruption

Even though fractures in children with immature spines occur predominantly in the upper cervical spine, isolated C-1 fractures are relatively rare. The fractures in almost all cases reported to date were considered stable due to the presence of the intact transverse ligament. The authors report the case of a young child who sustained a Jefferson fracture and in whom MR imaging revealed disruption of the transverse ligament. Although surgical treatment has been suggested as the treatment of choice for children with unstable atlantoaxial injuries, external immobilization alone allowed a full recovery in the patient with no evidence of instability at follow-up.

Download Full-text

Cervical malalignment after laminoplasty: relationship to deep extensor musculature of the cervical spine and neurological outcome

Journal of Neurosurgery Spine ◽

10.3171/spi-07/12/610 ◽

2007 ◽

Vol 7 (6) ◽

pp. 610-614 ◽

Cited By ~ 45

Author(s):

Haku Iizuka ◽

Takashi Nakajima ◽

Yoichi Iizuka ◽

Yasunori Sorimachi ◽

Tsuyoshi Ara ◽

...

Keyword(s):

Cervical Spine ◽

Neurological Outcome ◽

Neurological Recovery ◽

Cervical Lordosis ◽

Cervical Alignment ◽

Female Patients ◽

Group A ◽

The Mean ◽

Group B ◽

The Relationship

Object The goal of this study was to investigate the relationship between preservation of the insertion of the deep extensor musculature of the cervical spine at C-2 and postoperative cervical alignment, especially differences between cases involving male and female patients, as well as the relationship between the loss of cervical lordosis and neurological outcome after laminoplasty. Methods The authors reviewed the records of 50 patients who underwent laminoplasty to elevate the C-3 lamina with repair of the deep extensor musculature (Group A) and 31 patients who underwent laminoplasty by C-3 dome laminotomy or laminectomy (Group B). They compared the degree of cervical lordosis after laminoplasty with preoperative measurements. Neurological function at last follow-up was also compared with preoperative assessments. Results In Group A, the mean values for pre- and postoperative cervical lordosis were 14.5 and 10.9°, respectively (p > 0.18). In female patients, however, the pre- and postoperative means were 14.4 and 3.7°, respectively (p < 0.004). In Group B, the overall means for pre- and postoperative cervical lordosis were 17.3 and 19.1°, respectively (p > 0.48); the corresponding means for female patients were 15.0 and 14.1° (p > 0.83). The mean percentages of neurological recovery were 54.1% in Group A and 54.8% in Group B. Conclusions Preservation of the insertion of the deep extensor musculature to the C-2 spinous process prevented significant changes in cervical alignment after laminoplasty, even among female patients. Neurological recovery was not affected by the loss of cervical lordosis.

Download Full-text

Upper Cervical Spine Fracture-Dislocation in Patients With Ankylosing Spondylitis: Application of Halo Vest Before and During Posterior Surgery

10.21203/rs.3.rs-557216/v1 ◽

2021 ◽

Author(s):

Haisong Yang ◽

Yuling Sun ◽

Liang Wang ◽

Chunyan Gao ◽

Fengbin Yu ◽

...

Keyword(s):

Cervical Spine ◽

Ankylosing Spondylitis ◽

Spine Fracture ◽

Fracture Dislocation ◽

Cervical Spine Fracture ◽

Upper Cervical Spine ◽

Halo Vest ◽

Posterior Surgery ◽

Upper Cervical

Abstract Background It is a challenge to reduce and immobilize the broken “bamboo spine”, especially for the upper cervical spine, in patients with ankylosing spondylitis (AS) before and during posterior surgery. Methods We retrospectively analyzed the case histories, operations, neurologic outcomes, follow-up data, and imaging records of 17 patients with AS and upper cervical spine fracture-dislocation who underwent surgical treatment in three clinical spine center from 2010 to 2019. A halo vest was used to reduce and immobilize fractured spinal column ends. The neurological injury was evaluated using the American Spinal Injury Association (ASIA) impairment scale score and Japanese Orthopaedic Association (JOA) score before and after operation. Complications and time of bone fusion were recorded. Results Fourteen patients achieved closed anatomical reduction after halo vest application. No displacement in fracture ends and loss of reduction occurred after prone position. No patient presented with secondary neurological deterioration. All patients was performed posterior surgery. The surgery improved the ASIA grade in all patients (P < 0.001). The mean JOA score also increased significantly at last follow-up compared to preoperation (14.5 ± 2.3 vs. 9.2 ± 2.4, P < 0.01). No severe complication and death occurred. All patients reached solid bony fusion at 12-month follow-up. Conclusions Use of a halo vest before and during the operation is safe and effective in patients with AS who develop upper cervical spine fracture-dislocation. This technique makes positioning, awake nasoendotracheal intubation, nursing, and the operation more convenient. It can also provide satisfactory reduction and rigid immobilization and prevent secondary neurologic deterioration. .

Download Full-text

Result of the arc of movement of lower cervical spine after seven years of arthroplasty

Coluna/Columna ◽

10.1590/s1808-18512014130300446 ◽

2014 ◽

Vol 13 (3) ◽

pp. 185-187

Author(s):

Luis Claudio de Velleca e Lima ◽

Fernando Gritsch Sanchis

Keyword(s):

Cervical Spine ◽

Cervical Disc ◽

Lower Cervical Spine ◽

Lateral Bending ◽

Disc Disease ◽

Cervical Disc Replacement ◽

The Right ◽

Lost To Follow Up ◽

Surgery Center

OBJECTIVE: To quantify the mobility of the lower cervical spine after seven years of total cervical disc replacement at two levels. METHOD: This clinical study was designed randomly and prospectively at the spine surgery center at the Hospital Nossa Senhora das Graças, in Canoas, RS-Brazil and at the Hospital Don João Becker, in Gravataí, RS-Brazil. Seventeen patients were included in the study that was designed to compare the data obtained from annual and sequential manner until the end of seven years. A comparison was made with the prior range of motion (ROM) of each patient. All patients were diagnosed with not tractable symptomatic cervical degenerative disc disease with two adjacent levels between C-3 and C-7. RESULTS: A total of patients underwent TDR in two levels and at the end of seven years, only one patient was lost to follow-up. The pre and postoperative ROM was the same in the first three years however after the fourth year there was a gradual decline with a loss of 12% of preoperative ROM in flexion, 21% in extension and 23% in the right and left lateral bending at the end of seven years. CONCLUSIONS: The clinical outcome of this study is evidence level IV in evaluating the ROM for Moby-C(r) for TDR in two adjacent levels at the lower cervical spine. These results show that the ROM is maintained during the first three years, gradually declining after that.

Download Full-text

Relationship of T1 Slope with sagittal alignment parameters of the upper and subaxial cervical spine in patients with cervical lordotic and kyphotic curvature

10.21203/rs.3.rs-26626/v2 ◽

2020 ◽

Author(s):

Dong Sun ◽

Peng Liu ◽

Zhaolin Wang ◽

Jie Cheng ◽

Jianhui Mou ◽

...

Keyword(s):

Cervical Spine ◽

Sagittal Alignment ◽

Pearson Correlation ◽

Linear Regression Analysis ◽

Observer Agreement ◽

Group Differences ◽

Cervical Lordosis ◽

Cervical Alignment ◽

T1 Slope ◽

Subaxial Cervical Spine

Abstract Background: To identify the relationship between T1 slope and the sagittal alignment parameters of the upper and subaxial cervical spine in patients with cervical lordosis and kyphosis.Methods: Relevant sagittal radiographic parameters pertaining to patients with non-specific neck pain but with no associated neurogenic symptoms were retrospectively analyzed. Patients were categorized into lordotic alignment and kyphotic alignment groups based on the C2-C7 Cobb. Correlation among radiographic variables was assessed with the Pearson correlation coefficient and linear regression analysis. Between-group differences with respect to cervical alignment parameters were assessed with One-way Analysis of Variance.Results: Intra-observer and inter-observer agreement (two independent observers) was rated as excellent (kappa: 0.91 - 0.93). Inter-observer agreement for the two independent observers was rated as and substantial (kappa: 0.79 - 0.80), respectively. Significant between-group differences were observed with respect to C0-C1 angle, C1-C2 angle, C0-C2 angle, C2-C7 SVA (sagittal vertical axis) and TS-CL (T1 slope minus cervical lordosis) (P<0.01 for all), but not with respect to T1S (T1 slope) (P=0.367). In both groups, C2-C7 SVA showed a significant linear correlation with T1S (r2=0.712 vs. r2=0.467) and TS-CL (r2=0.810 vs. r2=0.248).Conclusion: This study showed that the two cervical alignment types (lordosis and kyphosis) have different angular variation in upper and subaxial cervical spine. With the increase in T1 slope, the upper cervical C0-C2 Cobb angle and the C2-7 SVA in the lordotic group were significantly higher than that of the kyphotic group. TS-CL mismatch may significantly impact lordotic cervical alignment in patients with lordosis.

Download Full-text